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Sleep Problems in Teens on the Autism Spectrum

Question

I'm a single mother and don't know how to deal with my 13 yr old anymore. He doesn't want to go anywhere or do anything which is hard when you have to, and I am now homeschooling him due to trouble going to school. A big problem right now is sleep issues… he is so active at night and tired during the day. At the moment he is not falling asleep till about 1 or 2 am, and I've tried waking him up earlier to reset his body clock but I can't get him out of bed. I don't know how to get him back into a healthy sleep routine.

Answer

Studies find that approximately 73% of kids with ASD level 1 (high-functioning autism) experience sleep problems, and these problems tend to last longer in this group than they do for kids without ASD. For example, kids on the spectrum are more likely to be sluggish and disoriented after waking. Laboratory research has begun to describe the unique physiological presentation associated with sleep problems in kids with ASD, including disruptions in the sleep stage most associated with cognitive functioning (i.e., REM or Rapid Eye Movement sleep). In addition to physiological differences, some of the sleep difficulties in this population may be related to anxiety.

The impact of poor sleep is unequivocal. Poor sleep negatively impacts mood and exacerbates selective attention problems commonly found in kids with ASD, as well as impairing other aspects of cognitive function.
 

There is no one panacea to manage sleep problems in autistic kids. However, there are many interventions that are likely to be helpful. In general, moms and dads need to understand and be prepared for resistance to change that these kids often show. Moms and dads should also be prepared for problems to get worse before they get better as kids often initially challenge but then gradually become accustomed to new routines.

A good place to start an intervention targeted at improving sleep is changing lifestyle behaviors and environmental conditions that can influence sleep/wake patterns. These include exercise, napping, diet, and aspects of the bedroom and sleep routine.

Exercise & Activity—

The goal is decreasing arousal as bedtime approaches. To achieve this it may be useful to have a scheduled period before bedtime (approximately 30-45 minutes) in which the aim is calmness and relaxation. During that period, media such as television, computers, electronic games, and music should be limited as they can stimulate the youngster through activity, sound, and light. 
 
The availability of VCR and DVR technology makes it easier to control when kids can watch particular shows, thereby avoiding conflict over missing favorite programs that are shown in the late evening. The presence of televisions in kid’s bedrooms has been consistently associated with sleep problems and should be avoided at all costs. Likewise, computer access in a youngster’s bedroom is discouraged for sleep as well as for safety reasons.

In general, exercise during the day is associated with better sleep. However, exercise within 2-4 hours of bedtime can lead to difficulties in falling asleep, as it can disrupt the natural cooling process of the body that leads to rest at night. Having the youngster soak their body, particularly their head, in a calm bath that is as warm as can be tolerated 90 minutes before bedtime may be useful too. 
 
When the youngster gets out of the bath, core body temperature will drop rapidly; this is believed to help them to fall asleep faster. Using a waterproof pillow and avoiding the pulsation associated with showers is recommended. The use of progressive muscle relaxation, deep breathing and imagery exercises is the most widely researched treatment for insomnia in kids and may be useful for kids with autism as well.

Napping—

Controlled and limited (e.g., 20-30 minutes) napping is generally positive. However, longer daytime sleeping can be negative in that it makes it more difficult for the youngster to fall asleep at the ideal time in the evening. If the youngster’s sleep problems are associated with falling asleep, which is common for kids on the spectrum, it is advisable to avoid daytime napping.

Diet—

It is recommended that kids with sleep problems avoid all caffeine, alcohol, tobacco, high fat food, and monosodium glutamate (MSG). In contrast, food rich in protein may promote better sleep. Large meals within 2-3 hours of bedtime should also be avoided. A small carbohydrate/protein snack, such as whole wheat bread and low-fat cheese or milk before bedtime can be helpful to minimize nighttime hunger and stimulate the release of neuro-chemicals associated with falling asleep. For kids who often wake during the night to use the bathroom, and then have trouble falling back asleep, limited fluid intake in the 2 hours prior to bedtime is also recommended.

Melatonin is a natural brain hormone associated with sleep onset. There is some evidence that natural production of melatonin may be reduced in these young people on the spectrum. While melatonin supplements may be useful, a common side effect may be increased sluggishness in the morning. As discussed above, this is already a common problem for kids with autism. Use of melatonin and other alternative remedies should be discussed with a physician.
 

The Bedroom—

It is important that the bed and the bedroom are associated with sleep and are not associated with activity. When kids have sleep problems, it is highly recommended that their bed and bedroom activity be limited to sleep only. It is important to make sure that extreme changes in temperature are avoided during the night. 
 
Increasing light is associated with decreases in the release of the neuro-chemical melatonin which triggers sleep onset. Thus, it is important to get the sunlight flowing in the youngster’s room as soon as possible in the morning. Conversely, darkening the room at night is critical. When a youngster’s fear of the dark is an issue, behavioral psychotherapy may be necessary. We also recommend moving the clock so that the youngster is not watching the time while lying in bed.

Sleep Routine—

Setting and maintaining a regular time to sleep and wake may be critical. Moms and dads often make the mistake of allowing their kids to sleep much later on non-school days to “make up” for sleep. While this may be useful to a certain extent, allowing the youngster to sleep late in the day makes it difficult for them to fall asleep at an ideal time later in the evening. It is easier to wake a sleeping youngster then to force an alert youngster to go to sleep. Thus, we recommend that you keep your youngster on a regular schedule on non-school days and avoid drastic changes in the time that the youngster wakes. 
 
Likewise, having your kids go to bed when they are not tired conditions them to be awake in bed. It is recommended that you let your kids stay up until they are tired while maintaining their waking time in the morning. Then once they begin falling asleep within 10 minutes of going to bed, begin to move bed time earlier by 15 minutes at a time.

With carefully monitoring and patience, many moms and dads can make changes in a youngster’s life that promote better sleep. Improved sleep supports better mood, sustained attention and general health. However, for many families professional consultation is often necessary to design or maintain the appropriate intervention. When you need help, speak with other moms and dads of special needs kids about their experiences and ask your primary care doctor for referrals to a sleep expert.
 
More resources for parents of children and teens on the autism spectrum:
 
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COMMENTS:
•    Anonymous said…  She said she was a single mom I assume she has to work to provide... so she may not be able to adjust her schedule... I am single mom of HFA 11yr old with simular issues... and I am debating homeschooling but I am only one person !!!!
 •    Anonymous said… Exactly my thought. We have a 6pm rule. No electronics after that time. Increased his exercise, and it works for us. No drugs needed. X
 •    Anonymous said… Exercise, no electronics on in the house after 6 (a bored brain is a tired one), wake up same time every time with daylight, and same basic diet. We do a fruit/veg/chia smoothie to start the day. My son loves to seek electronics at night (all electronics blocked during certain hrs and collect xbox and remotes every night)
 •    Anonymous said… Go to your GP and try him on Melatonin, a natural hormone that helps us to sleep. We produce it in our bodies but some have less than others hence the difficulty sleeping. It may take a little while to find the right dosage that is agreeable to his body. My son is 13 and is on it. He was like a new born with sleep patterns until he was 6 yrs old. By 11 I was going nuts. He is much better now thank goodness and gets the rest that his body and mind needs to grow and function properly. You may have to restrict the internet/pc use at night and reward him with it during the day only so as to encourage him to sleep at night. The 'blue light' projected from the pc/laptop suppresses the normal secretion of melatonin and doesn't really help ones circadian rhythms. Getting off any electronic devices atleast an hour or two before regular bedtime allows the brain to begin the whole process of slowing down and releasing that melatonin. Look, I for one know that all of this information works but unless we as the parents/carers put it into practise, our kids will never do it. I'm not perfect, some days I forget to give my son his dose at the right time and then he's struggling to wake up at the right time the next morning and so I pay the price with his bad mood and getting to school on time etc. But we all have to start somewhere right? He was doing the school refusal thing last year and not wanting to leave the house or socialise at all. We enlisted the help of a psychologist who specialised in ASD and the school and recommitted to being the driving force behind implementing new routines. Baby steps was and is what it takes at the moment for my son and I. Its so tough for him especially I know, as I'm sure it is for your son but we have to push them out of their comfort zones for them to face challenges and grow from them. How else will they grow and learn? They wont! Plain and simple. Unfortunately its up to us. We become their "Executive Secretaries" as stated in the book "The Complete Guide to Aspergers Syndrome" by Tony Attwood.
 I think I have gone on too much already but I hope you will find what your son needs to help him sleep and learn and grow. Wishing nothing but joy and success for our special Aspies!!!
 •    Anonymous said… i also have a 12 yrs old with similar tendancies. Our Pead told us to avoid any Blue lights (whether that be in ceiling light or of electronics) after 4pm as it over stimulates their brain. I am now also trying reading before bed. I feel your pain
 •    Anonymous said… I could have written this about my (undiagnosed) 11 year old. She also is now totally not Going to school (it's always been an issue but is much worse lately), she doesn't sleep and basically stays up all night every night (sometimes until 5-6am). She gets into bed ok at around11-12 but won't/can't sleep. She is very aggressive verbally and physically towards me almost all of the time and is very anxious. She doesn't go out with her friends or actually talk to them at all anymore. (She's never had tons of friends but now doesn't talk to the ones she did have) I'm also a single mum and have w younger daughter who is really effected by all this. It's so hard! I can't really offer any advice I'm waiting on things happening from the countless referrals that have gone in to community peads, cahms, child psychologist, education physcholigist etc xx
 •    Anonymous said… I guess it doesnt work for everyone. If there is a physical activity or sport that he likes to do then try to do it everyday as it will help use up that 'boy' energy during the day. A bath or warm shower at night, a warm drink, reading some stories, di...See More
 •    Anonymous said… If you're homeschooling anyway flip your schedule to match his. Do schoolin the afternoon. Theres a whole raft of studies about teen boys needing to sleep later. Make wake up time 10am and shift things. If the way everyone else does things isnt working for you and him create your own path.
 •    Anonymous said… I'm not a Dr but have Aspergers girls and their consultants prescribed "Melatonin" it worked a treat to get their bodies back in a sleep routine and we only use it now if required. Hope this helps xx
 •    Anonymous said… I've had similar issues, and since I've started to listen to his feelings, I work around him more now allowing him to sleep in as many days as possible, he is amuck happier boy all round for it 🏻
 •    Anonymous said… Melatonin did nothing for our grand son any thing else
 •    Anonymous said… My 8yr old grandson exactly the same.Wont go to school awake all night and his mum and dad cant get help for him in newzealand its shocking I feel sad for you.
 •    Anonymous said… My Aspie son has just turned 17 and his sleeping patterns starting changing at about 13yrs old. I know how you feel and it's really hard. I'm now told by UK Social that my son is neglected and we can't parent him because we don't enforce his sleeping pattern and he lives for the Internet (it's the only form of Social life the poor boy has!). Can you flipping believe it! I don't know what to suggest tbh, because as you know it's not like parenting our sons when they were little boys where they knew bed time was bed time. It gets so much more challenging.
Maybe go onto "The National Autistic Society" website and go onto the Members Forum (you can browse as a "Guest"). There are so many parents in the same boat trying to manage their Teens through to Adulthood.
 •    Anonymous said… my daughter doesnt go to bed till 1 or 2 am every day.....Melatonin diesnt wirk for her she needed stronger stuff but ended up ODing on perscription stuff....now we just let her stay up and I wake her at 7:45 for school every day
 •    Anonymous said… My daughter had similar sleep pattern issues thru the early teens (although she did lots of drama classes in the evenings so socializing wasn't an issue). All teenagers naturally will stay awake later and sleep in. The beauty of home ed is we can accomodate their changed natural bio rhythms. I treasured my mornings to myself and we did educational stuff in the afternoons/evenings. Is there anything he would like enough to entice him out of the house? Other than saying don't worry, it will pass (it did with my daughter and I miss those precious me time mornings!) I don't know what to advise. But try not to worry too much about the sleep, it is normal and entirely natural during puberty, as is needing more sleep, instead explore ways to get him outside.
 •    Anonymous said… My daughter takes melatonin a half hour before bedtime I give her 4mg in apple juice and she takes it other wise she would be up all night long. She's 12 and has been taking it since she was 2. No more sleep issues ever
•    Anonymous said… My Dr put my son on Clonidine 0.1mg to help him sleep at night otherwise he would be up all night
 •    Anonymous said… My son is 11 and has a similar pattern. He has been on increasing doses of melatonin for 3 yrs. The problem is it us meant to only be given for a month then nothing then for another month, in an attempt to train the body. The breaks just send my son back into vampire mode within days. He was quite sick for a few day so Dr prescribed phenegan for anti nausea. This knocked him out.... you can buy over the counter from Boots, alot if chemists won't sell it to you though. But I found that boots did when I explained my son was aspie and it calmed him down. Understand this is only used when the melatonin is wearing off and body is used to it. I use it maybe once a month just so he gets a decent nights sleep @weekend.
Maybe worth a try as I know many Dr's don't like to prescribe melatonin unless forced. We get all his meds through Camhs xx
 •    Anonymous said… Should talk to you'r doctor about what you can give him to help him sleep.May be you should look into a therapist to go to for help with your son. Has help with me.
 •    Anonymous said… Society imposes routines that aren't fit for all, if he's feeling ok and is willing to take responsibility for himself and things that need to be done then maybe you could be more flexible. I say this because my 13yo son is in a similar position, I worry that he doesn't have a social life but he's much calmer out of school and no longer being bullied. I'm a single parent too and have to leave him home alone while I go to work, but he's safer there than he ever was in school.
 •    Anonymous said… This sounds similar to what we experienced through the middle school years. Puberty is challenging for anyone, seems even more so for young people on the spectrum for some reason. Maybe because there was no go to rule book to reference since most info out there refers to neurotypical teens. It could be depression as well. Hang in there.
 •    Anonymous said… Turn electronics OFF
 •    Anonymous said… Unless you were/are an Aspie teenage with sleep problems, you dont have a clue what its like, it is not their fault REMEBER that! you can feed them all the tablets and chemicals you want but at the end of the day it only masks one of the many issue that we have to deal with, they are not the instigator they are the victim of their own biology.
 •    Anonymous said… we do 3 mgs of Melatonin at night. I was amazed at how much it helped my 7 year old. You can take breaks on weekends and holidays if you want but during the week we use it each night. He even said, "mom! I actually slept last night!!!"
 •    Anonymous said… We use 2 mg Clonidine and 3mg Melatonin for years. It was a life saver!
 •    Anonymous said… We use melatonin 20 minutes before bed with a warning that the tv,electrinics/internet,will be off soon. After 20 minutes we remove tv remotes,game paddles,etc and turn off the lights. Works for us.
 •    Anonymous said… Yes!! This can be a problem. Our teenager must have a sleep aid.
 •    Anonymous said… Yes, melatonin does nothing for my sleepless son also 🙁
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